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Sunday, January 9, 2022

Anxiety and PTSD linked to increased myelin in brain's gray matter

 A recent study links anxiety behavior in rats, as well as post traumatic stress disorder (PTSD) in military veterans, to increased myelin -- a substance that expedites communication between neurons -- in areas of the brain associated with emotions and memory.

The results, reported by scientists at the University of California, Berkeley, and UC San Francisco (UCSF), provide a possible explanation for why some people are resilient and others vulnerable to traumatic stress, and for the varied symptoms -- avoidance behavior, anxiety and fear, for example -- triggered by the memory of such stress.

If, as the researchers suspect, extreme trauma causes the increased myelination, the findings could lead to treatments -- drugs or behavioral interventions -- that prevent or reverse the myelin production and lessen the aftereffects of extreme trauma.

Myelin is a layer of fatty substances and proteins that wraps around the axons of neurons -- essentially, the insulation around the brain's wiring -- to facilitate long-distance transmission of signals and, thus, communication between distant areas of the brain. The inner regions of the brain look white -- in fact, they are referred to as "white matter" -- because of the myelin encasing the many large bundles of axons there.

But the new study finds increased myelination of axons in so-called "gray matter," where most of the cell bodies of neurons reside and most of the wiring is less insulated with myelin. The extra myelination was found primarily in areas associated with memory.

Researchers at the San Francisco Veterans Affairs Medical Center conducted brain MRI scans of 38 veterans -- half with PTSD, half without -- and found an increase in myelination in the gray matter of those with PTSD compared to that seen in the brains of those not suffering from PTSD.

Colleagues at UC Berkeley, meanwhile, discovered a similar increase in myelination in the gray matter of adult rats subjected to an acute stressful event. While not all rats showed long-term effects from the stress -- just as not all traumatized veterans develop PTSD -- those that did had increased myelination in specific areas of the brain associated with particular symptoms of stress that was identical to what UCSF physicians found in veterans with PTSD.

Both veterans with PTSD and stressed rats that exhibited avoidance behavior, for example, had increased myelination in the hippocampus, often thought of as the seat of memory. Those exhibiting a fear response had increased myelination in the amygdala, which plays a key role in our response to strong emotions, such as fear or pleasure. Those suffering from anxiety had increased myelination in the dentate gyrus, a region critical to learning and memory.

"The combination of these studies in rats with our population of veterans with post traumatic stress disorders is, to me, really exciting," said senior author Dr. Thomas Neylan, director of the Posttraumatic Stress Disorders (PTSD) Clinic and the Stress and Health Research Program at the San Francisco VA. "At least it's another mechanism to think about as we develop new treatments. If we see enduring ability to shape myelin content in an adult brain, maybe treatments will help reverse this. That's where we want to go next with this."

People -- and rats -- vary in their response to stress

The correlation between the symptoms and the region of myelination was discovered because UC Berkeley researchers subjected the rats to a battery of more than a dozen tests to assess their specific behavioral response to acute stress.

"We understand that there's a lot of individual variation in humans, but with rats, they're genetically identical, so you think when you expose them to stress you're going to get the same response," said senior author Daniela Kaufer, UC Berkeley professor of integrative biology. "But the response is extremely variable. They sort of fall into groups, such that some are really resilient, and some are vulnerable. And the ones that are vulnerable are vulnerable in different ways: Some show avoidance behavior, and some show fear learning problems, and some show startle responses that are exaggerated."

According to Neylan, similar individuality is seen in people with PTSD. The new study suggests that the specific symptoms are related to which areas of the brain are being newly myelinated.

"There's a lot of heterogeneity across different people with PTSD; it's not one size fits all. Every PTSD patient generally has a mix of different symptoms," said Neylan, professor-in-residence in psychiatry at the UC San Francisco Weill Institute for Neurosciences. "Some people are very avoidant. Some people are very hyperreactive. The idea is that if you can show that these different symptom clusters have different neural circuitry, it might actually lead us closer to subtyping people in a way that we could be more targeted in our treatment."

The researchers, who published their results in December 2021 in the journal Translational Psychiatry, show that stress produces more of the brain's glial cells, called oligodendrocytes, which wrap around the axons of neurons and make the myelin. The increased myelin produced by these new oligodendrocytes could affect the speed of connections between neurons, making some connections hyperresponsive.

"In the gray matter of your cortex, most of the dendrites and axons -- the projections that come out of the neurons that help establish communications with other neurons -- can form thousands of connections, and most of them are unmyelinated," Neylan said. "But if experience leads you to start to lay down myelin to strengthen certain connections, let's say your ability to respond quickly to a fearful stimulus, you can speed up that circuit, but you lose the kind of broader adaptive flexibility that you normally would have with mostly unmyelinated axons and dendrites. People with PTSD become almost like a one-note musician -- they really know how to respond to fear. But that enhanced, quick response to fear may diminish their adaptive flexibility for non-fear-type behavior."

Acute stress boosts oligodendrocytes

In 2014, Kaufer and her UC Berkeley colleagues discovered that rats subjected to acute stress produced more oligodendrocytes in the brain's gray matter -- specifically, in the hippocampus. She proposed that this led to increased myelination of axons, potentially interfering with the speed at which signals traveled between different areas of the gray matter of the brain, such as the hippocampus and the amygdala. The new study bolsters that theory.

Neylan was intrigued by the 2014 findings and contacted Kaufer, and they've been collaborating ever since. Neylan teamed up with Linda Chao, UCSF professor of radiology, who developed a way to image myelin in the gray matter of the brain, and several years ago scanned the brains of 38 veterans who had experienced severe trauma, some with and some without PTSD.

At the time, scientists looking for changes in myelination related to brain disorders were focused on the cortex's white matter, which is mostly myelinated. In multiple sclerosis, for example, an autoimmune attack destroys myelin in the white matter. Kaufer was perhaps the first to find evidence of increased myelination in the gray matter associated with disease.

Chao and Neylan did find increased myelination of neurons in the gray matter of veterans with PTSD, but not in those without PTSD. The worse the symptoms, the greater the myelination.

This led Kaufer and first author Kimberly Long, now a UCSF postdoctoral fellow, to see if they could also find increased myelin in gray matter after acute trauma in rats. After they focused on the specific symptoms of individual rats with PTSD, they found a correlation between symptoms and myelination in specific regions of the gray matter.

Chao subsequently reanalyzed the brain scans of her earlier group of 38 veterans and found the same correlation: Specific symptoms were associated with myelination in one region of gray matter, but not others.

Long and Kaufer then employed a type of viral gene therapy to rev up a transcription factor, called olig1, that increases the production of oligodendrocytes from stem cells in the gray matter. When Long injected the virus into the dentate gyrus of rats, the researchers found that this boosted the number of oligodendrocytes and generated symptoms of avoidance, even without any stress.

"The next question was, 'If I change oligodendrocyte genesis, am I going to change behavior?" Kaufer said. "The beginning of an answer is here in this paper -- it's yes. And now, there's a lot more to do to really understand that."

Neylan, Chao and Kaufer are collaborating on further studies, including looking for increased myelin in the brains of PTSD patients who have died, improving fMRI imaging of myelin in the brain, investigating the effects of chronic stress on the brain connections of rats, and using new high-resolution imaging to study the myelin deposition in gray matter.

The work was supported by a grant from National Institute of Mental Health of the National Institutes of Health (R01MH115020).

Other co-authors of the paper were undergraduates Yurika Kazama, Vivian Roan, Rhea Misra, Anjile An, Kelsey Hu, and Claire Toth and doctoral student Jocelyn Breton of UC Berkeley; UCLA undergraduate Lior Peretz; University of Arizona undergraduate Dyana Muller; University of British Columbia (UBC) doctoral student William Casazza; UBC professor Sara Mostafavi; Boston University neurologist Dr. Bertrand Huber; and researcher Steven Woodward of the VA Palo Alto Health Care System.


Story Source:

Materials provided by University of California - Berkeley. Original written by Robert Sanders. Note: Content may be edited for style and length.


Journal Reference:

  1. Kimberly L. P. Long, Linda L. Chao, Yurika Kazama, Anjile An, Kelsey Y. Hu, Lior Peretz, Dyana C. Y. Muller, Vivian D. Roan, Rhea Misra, Claire E. Toth, Jocelyn M. Breton, William Casazza, Sara Mostafavi, Bertrand R. Huber, Steven H. Woodward, Thomas C. Neylan, Daniela Kaufer. Regional gray matter oligodendrocyte- and myelin-related measures are associated with differential susceptibility to stress-induced behavior in rats and humansTranslational Psychiatry, 2021; 11 (1) DOI: 10.1038/s41398-021-01745-5

Fed agencies prepare to act against unvaccinated employees

 Federal government agencies are preparing to take increasingly harsh steps against unvaccinated employees in order to implement President Biden’s COVID-19 vaccine mandate for federal workers.  

Some agencies plan to send letters warning of possible suspensions to employees who have not complied with the mandate. Many are also prepared to fire employees who don’t follow the rule, though such moves would be further down the road.

The rate of compliance is high across the federal government and agencies say they do not expect the suspensions or firings to cause disruptions.

The White House in November told agencies to hold off on harsher penalties until after the new year and to focus on education and counseling for those who had not complied with the mandate. Now, the Office of Management and Budget (OMB) says agencies can move forward with stricter measures at their discretion.  

“Agencies continue to move forward with the process, including taking progressive disciplinary measures as necessary,” an OMB spokesperson told The Hill. 

The COVID-19 vaccine mandate for federal workers is a cornerstone of Biden’s coronavirus response. The deadline for federal workers to comply with the mandate was Nov. 24, when 92 percent of the 3.5 million employees working for the federal government had received at least one dose of a COVID-19 vaccination.

The current rate of federal government-wide compliance with the mandate is unclear because some agencies did not provide up-to-date data when reached by The Hill, but several agencies reported making progress since the November deadline by counseling employees who had not received their shots.  

The departments of Treasury, Transportation and Agriculture, as well as the General Services Administration, Social Security Administration and Nuclear Regulatory Commission are all expected to begin suspending employees who are not complying with the mandate in the coming weeks. 

Agencies have not laid out specific time frames for notifying employees of the suspensions, but experts expect them to move relatively quickly given that four months have passed since Biden announced the rule. 

The federal government employs a sprawling workforce and the vaccine policy impacts the bulk of its 3.5 million workers. Health experts view the federal mandate as powerful, especially given that Biden’s other vaccine mandates, for large businesses and healthcare workers, are tied up in court proceedings.  

The Supreme Court’s conservative members on Friday appeared skeptical of Biden’s COVID-19 vaccine-or-test mandate for private sector businesses with 100 or more employees and questioned if the administration has the legal authority for the policy.

“It’s very important because the federal workforce is huge and it extends across the country and not just in Washington, D.C. It also I think sets the tone for cities and states to do it for their own public service workers and ultimately to encourage private sector companies to do it,” said Lawrence Gostin, a public health law professor at Georgetown University. 

“If the federal government can show that this can be implemented seamlessly without a lot of pushback and without a lot of people leaving the workforce, that will be encouraging to cities and states and also the private sector to follow suit,” Gostin said.

While the vast majority of employees across the government have complied with the mandate, the most current data suggests at least a few thousand employees have not gotten the vaccine or presented a valid medical or religious exemption from the policy. 

As of this week, the White House and the Department of Education had both reached full compliance, the first known agencies to do so. 

At the Department of Education, roughly 3,900 employees either received at least one dose of a vaccine or have a pending or approved exception. The department also has a 97 percent vaccination rate, which includes only employees who are vaccinated with the first and second dose.  

The roughly 3,900 employees of the department either received at least one dose of a vaccine or have a pending or approved exception. The department also has a 97 percent vaccination rate, which includes only employees who are vaccinated with the first and second dose. 

Some agencies also saw success in convincing unvaccinated workers to get the shot towards the end of the year. The Social Security Administration, for instance, as of Friday had achieved a 98.9 percent compliance rate and a 91.5 vaccination rate, compared with a 95 percent compliance rate and 87.7 percent vaccination rate as of November. 

A Transportation Department spokesperson also said that the department “saw more compliance following education and counseling steps completed in December and next steps of the enforcement process will involve letters warning of brief suspensions for those few still not in compliance.” 

The department says that 99.9 percent of its roughly 52,500 employees are vaccinated with at least one dose or have a pending or approved exception or extension request, meaning only about 50 employees are not in compliance with the mandate.  

Other agencies have larger numbers of unvaccinated workers who aren’t complying with Biden’s mandate.  

Just under 98 percent of the Department of Agriculture’s 75,955 permanent employees are complying with the mandate, meaning about 1,587 employees are facing counseling and potentially more drastic measures. 

With a 99 percent compliance rate, almost 960 out of 95,800 Treasury Department employees are not vaccinated and don’t have a pending or approved exception. 

When reached by The Hill, multiple agencies insisted they do not expect suspensions or firings due to the vaccine mandate to adversely impact critical government operations. 

Gostin said it would take a fair amount of planning to ensure that federal functions are not disturbed by any suspensions or firings, suggesting that agencies implement phased suspensions or removals and begin recruiting new workers to fill any vacancies. He also said that the government needs to implement a sound vaccine verification system. 

“There is a lot of experience in the federal government to make sure that operations continue even when you have workforce disruptions,” said Gostin, who pointed to preparations for government shutdowns and severe weather. “The important thing is to make sure that disruptions are minimal.”  

https://thehill.com/homenews/administration/588836-federal-agencies-prepare-to-act-against-unvaccinated-employees

Saturday, January 8, 2022

China's Tianjin starts citywide COVID-19 testing

 North China's Tianjin, a municipality that neighbors Beijing, has decided to start a citywide nucleic acid testing after 20 people were tested positive for COVID-19, authorities said Sunday.

The infections were reported from 6 p.m. Friday to 9 p.m. Saturday in Jinnan District, and the gene sequencing found the first two locally-confirmed cases were infected with the VOC/Omicron variant, according to the municipal center for disease control and prevention.

It is not confirmed yet whether the infections are related to the imported case of Omicron variant infection in the city.

The citywide nucleic acid testing is expected to complete in 24 hours in four districts from 7 a.m. Sunday and in 12 other districts from 7 a.m. Monday, and residents will not be given a green health code until receiving the negative testing result, the center said.

http://www.xinhuanet.com/english/20220109/d0dc544b95c8478187620d5fd21758c1/c.html

Ultragenyx Collaboration with Regeneron Intriguing, But Own Pipeline Progress Remains Key - Stifel

 Stifel analyst Dae Gon Ha reiterates a "Buy" rating on shares of Ultragenyx Pharma (NASDAQ: RARE.

https://www.streetinsider.com/Analyst+Comments/Ultragenyx+Pharma+%28RARE%29+Collaboration+with+Regeneron+%28REGN%29+is+Intriguing%2C+But+Own+Pipeline+Progress+Remains+Key+-+Stifel/19435446.html

argenx (ARGX) PT Raised to $382 at Wedbush After Strategic Business Update

 Wedbush analyst David Nierengarten raised the price target on argenx SE (ARGX:BB) (NASDAQ: ARGX) to $382.00 (from $362.00) 

https://www.streetinsider.com/Analyst+Comments/argenx+SE+%28ARGX%3ABB%29+%28ARGX%29+PT+Raised+to+%24382+at+Wedbush%2C+Following+Strategic+Business+Update/19435969.html

SEIU-UHW Decry California Opening Door to Forcing COVID-Positive Caregivers Back to Work

  Healthcare workers across California are expressing shock and anger at the January 8th guidance issued by the California Department of Public Health allowing acute care hospitals, psychiatric hospitals and skilled nursing facilities to bring healthcare workers back to work after they have tested positive for COVID-19 or been directly exposed without any testing or isolation periods.  

Caregivers predict that compromising common sense safety requirements for testing and isolation will increase workplace outbreaks and put vulnerable patients at grave risk.

"For healthcare workers on the frontline it is very disappointing to see the State of California cave to employer pressure to bypass common sense safety measures," said Gabe Montoya, an emergency room technician at Kaiser Medical Center in Downey. "No patient wants to be cared for by someone who has COVID-19 or was just exposed to it. There is testing available at our facilities and we should be able use that testing and test negative before returning to work if we are exposed or have tested positive. Caregivers need to be able to trust that the CDC and the State are putting the safety of patients and healthcare workers first."

"Hospital workers cannot take much more," adds Gisela Thomas, a respiratory therapist at Desert Regional Medical Center in Palm Springs. "Rather than compromising workplace safety precautions, we need bolstering from state policy makers.  California healthcare workers need paid COVID sick leave to support us when we contract COVID-19 while caring for patients and recognition bonuses to keep people on the job in the face of massive staffing shortages." 

SEIU-United Healthcare Workers West (SEIU-UHW), the union representing 100,000 California Healthcare workers vowed to protest the new guidance. The guidance is not binding on hospital employers who are allowed to maintain stricter precautions such as a requirement for a negative test before a COVID-19 positive or exposed healthcare worker returns to work. 

"Our union will fight for safe working conditions for hospital workers who have continuously put their lives on the line during this pandemic," says Dave Regan, president of SEIU-UHW. "We intend to expose any hospital employer who knowingly puts patients at risk by forcing COVID positive caregivers back to work." 

SEIU-UHW members include frontline workers such as respiratory care practitioners, dietary, environmental services, and nursing staff who live and work throughout California from the Bay Area to Sacramento and Los Angeles to the Central Valley.

https://www.streetinsider.com/PRNewswire/SEIU-UHW%3A+Healthcare+Workers+Decry+California+Opening+the+Door+to+Forcing+COVID-Positive+Caregivers+Back+to+Work/19437907.html

Unions petition to keep OSHA pandemic protections for health workers in place

 

  • A coalition of major labor unions petitioned an appeals court on Wednesday to force the Biden administration to make permanent its emergency temporary standard for healthcare workers during the pandemic.
  • The Occupational Safety and Health Administration implemented the emergency temporary standard in June, mandating hospitals and other healthcare facilities follow requirements around ventilation, physical barriers and other protections intended to reduce virus transmission. The agency announced it would withdraw the rule in December, without replacing it with a permanent standard.
  • Nursing unions like National Nurses United, the New York State Nurses Association and Pennsylvania Association of Nurses and Allied Professionals, along with labor unions representing teachers and other workers, petitioned the U.S. Court of Appeals for the D.C. Circuit to compel OSHA to quickly codify a permanent standard on occupational exposure.

Labor unions representing front line workers in particular have fought hard for greater workplace protections throughout the pandemic amid shifting guidance from government agencies and employers.

The emergency temporary standard issued in June was a major win for them, making previous pandemic guidance like masking and social distancing mandatory for healthcare providers at facilities where suspected or confirmed coronavirus patients are treated.

Healthcare employers though pushed back, noting the rule was long and complex, carrying a variety of exemptions for vaccinated employees, and had a quick compliance date and short comment period.

They will no longer have to follow the ETS as OSHA effectively dissolved it. But labor unions are again fighting for those protections to be made permanent.

"The nation's nurses remember well how, before the June 2021 OSHA standard, health care employers frequently denied their employees protections and policies such as personal protective equipment, testing, isolation, and more," the country’s largest nursing union, National Nurses United, said in a release on the suit.

NNU noted on Dec. 28, the day after OSHA announced plans to rescind the ETS, the seven-day average for new COVID-19 cases broke all previous records when it reached 267,000 cases.

"The grave danger that led to issuance of the emergency temporary standard not only remains, but has dramatically increased with the omicron variant and current surge in infections and hospitalizations," the union said in the release.

For its part, OSHA said when it rescinded the temporary guidance that healthcare workers were still protected by other standards, and urged all healthcare employers to continue abiding by the emergency temporary standard's requirements.

https://www.healthcaredive.com/news/nurses-labor-unions-petition-OSHA-ETS-permanent/616767/